Predicting blood flow near hepatic tumors with ultrasound to improve RF ablations

描述（由申请人提供）：【目的】本研究旨在提高射频（RF）消融的肝癌肿瘤根除率，增加候选患者数量。相关性对于小于3cm的原发性或继发性肝恶性肿瘤，射频消融治疗的局部肿瘤根除率超过83%；不幸的是，大多数患者的肿瘤大于3cm。由于射频装置在不同患者之间甚至同一患者内部产生的热损伤大小存在不可预测的差异，较大肿瘤局部肿瘤根除的成功率低于50%。治疗成功率受到局部血流的限制，血流带走了治疗过程中所施加的热量，这可能导致一些肿瘤细胞达不到55℃的细胞死亡温度，并导致疾病的延续和传播。目的：提出一种利用三维超声图像定量肿瘤周围感兴趣区域（ROI）内血流量的新方法。血流信息将被评估为射频消融设备性能的预测指标，供临床医生在消融计划中使用，以确保所有肿瘤细胞被破坏，而健康组织被干扰的数量最少(对患有

DESCRIPTION (provided by applicant): [Aim The proposed research is intended to increase the liver cancer tumor eradication rate of Radiofrequency (RF) ablation and increase the number of candidate patients. Relevance The local tumor eradication rate for patients with primary or secondary malignant liver tumors smaller than 3cm who are treated using Radiofrequency (RF) ablation is over 83%; unfortunately, the majority of patients have tumors larger than 3cm. The success rate of local tumor eradication of larger tumors falls to less than 50% due to unpredictable variation in the size of the thermal injury created by RF devices between different patients and even within the same patient. The success rates are limited by local blood flow carrying away the heat applied during treatment which can result in some tumor cells not reaching the cell death temperature of 55¿C and an undesired continuation and propagation of the disease. Objective The proposed research develops a new method of quantifying the amount of blood flow within a Region of Interest (ROI) surrounding a tumor using 3D ultrasound imagery. The flow information will be evaluated as a predictor of RF ablation device performance for use by clinicians during ablation planning to ensure that all of the tumor cells are destroyed and a minimal amount of healthy tissue is disturbed (critical for patients with cirrhosis). Methods Software based algorithms will be developed to reconstruct patient specific liver vessel geometry from 3D ultrasound Imagery. The associated Doppler color/velocity data from within the patient vessels will be combined with angle corrected vessel geometry to establish a "Flow Influence Index" within the ROI set around the tumor by the clinician. The index will provide an indication of the amount and direction of local blood flow. The algorithm function will be verified with an anatomically correct liver flow model of known geometry over a range of normal and pathological flow rates. The predictive capability of the algorithms will be validated by planning and performing test ablations on discarded cattle livers and comparing the planned and actual ablation sizes.]